Roldan Paola, McGrath Lidija, Patel Karishma, Brookfield Kathleen, Pare Emmanuelle, Khan Abigail
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
Oregon Health & Science University School of Medicine, Portland, OR, USA.
Int J Cardiol Congenit Heart Dis. 2021 Dec 16;7:100305. doi: 10.1016/j.ijcchd.2021.100305. eCollection 2022 Mar.
Arrhythmias are a common complication in pregnant women with heart disease. While continuous electrocardiographic monitoring is a useful tool for diagnosis, it also has significant associated costs, and identifying which pregnant women are most likely to benefit from monitoring is an important goal.
This is a retrospective observational study of pregnant adult women with heart disease cared for at an academic medical center between 2016 and 2020. Clinical information and ambulatory and inpatient monitoring results were abstracted from the electronic health record and descriptive statistics and T-tests were used to characterize the population.
A total of 258 pregnancies in 202 unique women were included. The most common type of cardiovascular disease was congenital heart disease (56.6%), followed by cardiomyopathy (11.2%). An ambulatory monitor was ordered in 26.7% of pregnancies in the antepartum period, and 26.1% of these had clinically significant findings. 46.4% of monitors resulted in a clinical management change, with the most common changes being no recommendation for intrapartum electrocardiographic monitoring (20.3%) and starting a new medication (14.5%). Continuous electrocardiographic monitoring was used in 54.8% of deliveries, and detected a significant arrhythmia in only 2 cases (0.1%).
A symptom driven protocol for ambulatory monitoring in pregnancy yields abnormal findings in a significant proportion of patients, and nearly half trigger a change in clinical management. Intrapartum electrocardiographic monitoring has a low yield, with a significant arrhythmia detected in less than 1% of pregnancies in this cohort.
心律失常是患有心脏病的孕妇常见的并发症。虽然连续心电图监测是诊断的有用工具，但它也有显著的相关成本，确定哪些孕妇最有可能从监测中获益是一个重要目标。
这是一项对2016年至2020年在一家学术医疗中心接受治疗的成年心脏病孕妇进行的回顾性观察研究。从电子健康记录中提取临床信息、动态和住院监测结果，并使用描述性统计和t检验对人群进行特征分析。
共纳入202名女性的258次妊娠。最常见的心血管疾病类型是先天性心脏病（56.6%），其次是心肌病（11.2%）。26.7%的妊娠在产前阶段进行了动态监测，其中26.1%有临床显著发现。46.4%的监测导致了临床管理的改变，最常见的改变是不建议进行产时心电图监测（20.3%）和开始使用新药物（14.5%）。54.8%的分娩使用了连续心电图监测，仅在2例（0.1%）中检测到显著心律失常。
症状驱动的孕期动态监测方案在很大比例的患者中产生异常发现，近一半会引发临床管理的改变。产时心电图监测的阳性率较低，在该队列中不到1%的妊娠中检测到显著心律失常。
